Skin and wound care
MildErythema (redness) of skin only. |
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ModerateErythema (redness), with less than 50% broken skin. Oozing and/or bleeding may be present. |
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SevereErythema (redness), with more than 50% broken skin. Oozing and/or bleeding may be present. |
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TreatmentPrevention/mild IRDCleanse skin e.g. foam cleanser or pH balanced product. Apply moisturiser +/or skin protectant e.g. barrier cream/film which does not affect absorbency of continence products. Moderate/severe IRDCleanse skin e.g. foam cleanser or pH balanced product. Apply liquid/spray skin protectant or barrier preparation, if no improvement refer to local guidelines or seek specialist advice. Note: observe for signs of skin infection, e.g. candidiasis, and treat accordingly (do not use barrier films as this will reduce effectiveness of treatment). |
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Scottish incontinence related dermatitis skin damage tool
Skin damage due to problems with moisture can present in a number of different ways. This tool aims to help you identify the cause to aid in decision making for treatments.
Moisture may be present on the skin due to incontinence (urinary and faecal), perspiration, wound exudate or other body fluids e.g. locia, amniotic fluid.
Lesions caused by moisture alone should not be classified as pressure ulcers.This Scottish incontinence related dermatitis skin damage tool is also available in PDF format.
Skin damage due to exposure to urine, faeces or other body fluids.
LocationLocated in peri-anal, gluteal, cleft, groin or buttock area. Not usually over a bony prominence. |
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ShapeDiffuse often multiple lesions. May be ‘copy’, ‘mirror’ or ’kissing’ lesion on adjacent buttock or anal-cleft. Linear. |
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EdgesDiffuse irregular edges. |
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NecrosisNo necrosis or slough. May develop slough if infection present. |
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DepthSuperficial partial thickness skin loss. Can enlarge or deepen if infection present. |
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ColourColour of redness may not be uniform. May have pink or white surrounding skin (maceration). Peri-anal redness may be present. |
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These are lesions where a combination of pressure and moisture contribute to the tissue breakdown. They still need to be graded as pressure damage but awareness of other causes and treatments is needed. See Pressure ulcer grading tool. |
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...HCPs or support staff can assess using patient questions and clinical observations (adapted from Harte and Marshall, 20251):
Questions to ask the patient:
- Have you noticed any changes to your skin in this area?
- Does the area feel different compared to the surrounding skin?
- Are you experiencing pain, itching or other changes in sensation?
- Are there any parts of your skin that feel swollen, sore or leaking fluid?
Observations to make:
- Look for widespread, diffuse or blotchy erythema.
- In patients with dark skin tones, note subtle darkening, textural changes or loss of normal skin markings rather than erythema alone.
- Assess for patches of skin breakdown or partial-thickness loss.
- Check whether the skin feels unusually warm to the touch.
- Look for any exudate or bleeding.
Reference:-
1. Harte S and Marshall A (2025) Moisture-associated skin damage – exploring the four pillars of skin damage and providing practical solutions. Wounds UK 21(1) 74–8.
Best Practice Statement (2025) Understanding types of moisture-associated skin damage (MASD): prevention, identification and management. London: Wounds UK. Available to download from: www.wounds-uk.com
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